Facility Evaluation Report

On 04/14/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA met with staff member (SM), Mater Panaligan and explained the purpose the visit. LPA asked the SM Panaligan call the Facility Designated Administrator (FDA), Tabitha Antonia to inform them that CCL was present at this time. Shortly after, LPA met with FDA Antonia and explained the purpose of the visit.

This facility is licensed to serve and retain 5 residents who are 60 or older. All of which may be non-ambulatory. This facility also holds a Dementia Program on file and has a Hospice Waiver for 6.

Current census was 5. However, 1 out 5 residents were out of the facility at this time. There is one resident on hospice at this time.

LPA reviewed 5 resident files and 3 staff files. All files were current and up to date. The Facility Designated Administrator (FDA) has an active administrator certificate #7033720740 and expires on 1/27/2028.

LPA Pascua observed a locked centralized stored medication cabinet located in the dining room. Along with Administrator, the LPA observed, reviewed, and compared resident medication with the medication dispensing logs. First Aid Kit was present and contained all of the required components.

The fire extinguisher, located in the kitchen area, was serviced by Jorgenson Company on 02/02/2026. Carbon Monoxide and fire alarms were present and in good repair.

Common areas for resident use were toured. Furniture and furnishings were observed to be present and in compliance.